Drug Therapy for PUD/GERD

What is the prototype for Histamine2 Receptor Agonists?

Cimetidine

How does Cimetidine work?

Blocks the secretion of gastric acid

Why is Cimetidine used?

Prevents/treats gastric and duodenal ulcers, GERD, hypersecretory conditions, heartburn, and used in conjunction with antibiotics for H. pylori and urticaria

What are the AE of Cimetidine?

• Decreased libido, impotence, and gynecomastia (i.e., males)

• CNS effects (i.e., crosses the BBB and more likely in geriatric)

• Constipation, diarrhea, and nausea

What are Cimetidine’s CI?

Pregnancy, geriatric clients (i.e., increased CNS effects), clients at high risk for pneumonia (i.e., patients with COPD), and reduction in dose for kidney patients

What are Cimetidine’s DI?

Can inhibit enzymatic metabolism of drugs, thereby increasing levels of meds like warfarin, phenytoin, theophylline, and lidocaine (i.e., meds with a narrow margin for safety)

What are the nursing interventions for Cimetidine?

Check drug levels and PT/INR, monitor for bleeding, pneumonia, and side effects, check medication list, and teach about compliance and diet

What is the prototype for Proton Pump Inhibitors?

Omeprazole

How does Omeprazole work?

Blocks basal and stimulated acid production

• Reducing acid by inhibiting the enzyme that produces gastric acid

• Irreversible inhibition

Why is Omeprazole prescibed?

Short-term therapy (i.e., 4-8 weeks) for gastric/duodenal ulcers, erosive esophagitis, GERD, and prevention of stress ulcers

What are Omeprazole’s AE?

Pneumonia, osteoporosis/fractures, rebound hypersecretion, hypomagnesemia, c. diff, and GI side effects

What are Omeprazole’s CI/precautions?

Pregnancy (i.e., indications of congenital birth defects) and patients who have a high risk for pneumonia (i.e., think COPD and the immunosuppressed)

What are the Omeprazole’s DI?

Digoxin, phenytoin, clopidogrel, -azoles, benzos, and antivirals

What are Omeprazole’s nursing interventions?

Watch for signs of thrombotic events in patients taking clopidogrel and monitor for diarrhea or loose stools, sign and symptoms of pneumonia, and hypomagnesemia

What is the prototype for Mucosal Protectants?

Sucralfate

How does Sucralfate work?

Turns into a physical protective barrier for an ulcer up to 6 hours, but does not affect acid

Why is Sucralfate prescribed?

Duodenal ulcers/maintenance and neutralizing gastric acid

What are Sucralfate’s AE?

Constipation (i.e., increase fiber) and dry mouth

What are Sucralfate’s CI/precautions?

Pregnancy and lactation

What are Sucralfate’s DI?

Phenytoin, digoxin, warfarin, ciprofloxacin, and antacids

What are Sucralfate’s nursing interventions?

Take this medication 1-2 hours before a meal to maximize effectiveness and keep proper intervals between other meds and this one, usually 2 hours

What is the prototype for Prostaglandin E Analog?

Misoprostol

How does Misoprostol work?

Decreases acid secretion, increases the secretion of bicarb and mucus, and promotes vasodilation

Why is Misoprostol prescribed?

Long-term NSAID use to prevent ulcers and off-label uses that include inducing labor and medical termination of a pregnancy

What are Misoprostol AE?

Diarrhea and dysmenorrhea

What are Misoprostol CI/precautions?

Pregnancy (i.e., category X) and lactation

What are Misoprostol DI?

Some diarrhea with antacids

What are Misoprostol’s nursing interventions?

Ask women about menstrual cycles and contraceptives

What is the prototype for Antacids?

Aluminum hydroxide

How does Aluminum hydroxide work?

Neutralizes stomach acid

Why is Aluminum hydroxide prescribed?

GERD and prevention of stress ulcers and PUD

What are Aluminum hydroxide’s AE?

Constipation, fluid retention (i.e., if sodium containing), electrolyte imbalances, alkalosis, and magnesium toxicity

What are Aluminum hydroxides CI/precautions?

• Use in caution with patients with heart failure or hypertension (i.e., b/c of the sodium)

• Do not use in patients with abdominal pain or GI perforation/obstructions

• Careful with renal and hepatic patients

What are Aluminum hydroxides DI?

Delays the absorption of other meds b/c the the aluminum compound binds to drugs like warfarin, digoxin, and tetracycline interfering with absorption and reducing their effects

What are Aluminum hydroxides nursing interventions?

Do not take these meds within 1-2 hours of other medications (i.e., it will interfere with absorption) and assess for side effects and therapeutic action

What is the prototype for digestive enzymes?

Pancrelipase

How does Pancrelipase work?

Replaces pancreatic enzymes to aid in the digestion/absorption of fats, proteins, and carbs

Why is Pancrelipase prescibed?

Replacement treatment in those with a deficiency of exocrine pancreatic enzymes

What are Pancrelipase AE?

GI irritation, HA, and cough

What are Pancrelipase’s CI/precautions?

Pork allergy, pregnancy/lactation, and gout/hyperuricemia

What are Pancrelipase DI?

Decreases the absorption of folic acid and iron

What are the nursing interventions for Pancrelipase?

This medication is taken with every meal and snack